ILUMINA LIFE CENTER, P.C.


Address: 211 Granite Run Dr Ste 221, Lancaster, PA 17601
Phone: 8144674055

ILUMINA LIFE CENTER, P.C. (NPI# 1467852996) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1467852996
Entity Type Organization
Organization Name ILUMINA LIFE CENTER, P.C.
Other Organization Name REGENERATIVE SPINE AND WELLNESS CENTER
Practice Address 211 Granite Run Dr Ste 221
Lancaster
PA 17601
Mailing Address 247 York Rd
Carlisle
PA 17013-3157
Practice Telephone 8144674055
Mailing Telephone 8144674055
Mailing Fax Number 8142544092
Enumeration Date 2014-09-03
Last Update Date 2018-07-05
Authorized Official Name MS. FLORENTINA MAYKO (CEO)
Authorized Official Telephone 8144674055
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 261QP3300X Clinic/Center
Specialization: Pain
Ambulatory Health Care Facilities
Y 261QM1300X Clinic/Center
Specialization: Multi-Specialty
Ambulatory Health Care Facilities

Other Provider/Organization Names

Other Name Type Code
Regenerative Spine and Wellness Center Doing Business As Name - Organization

Provider Secondary Practice Location

Address Telephone Number Fax Number
136 Jaycee Dr, Suite 10, Johnstown, PA 159043650 8144674055 8142628161
507 Tire Hill Rd Ste 100, Johnstown, PA 159057311 8144674055 8142544092

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1295101715 Ilumina Life Center, P.C. Pain Medicine 507 Tire Hill Rd, Suite 100, Johnstown, PA 15905-7311 2015-08-19
1942686753 Ilumina Life Center, P.C. Pain Medicine 418 N Logan Blvd, Suite B, Burnham, PA 17009-1816 2015-08-04

Office Location

Street Address 211 GRANITE RUN DR STE 221
City LANCASTER
State PA
Zip Code 17601

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NPI Name Taxonomy Address Enumeration
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Taxonomy Information

Taxonomy Code 261QM1300X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Multi-Specialty

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
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1205860558 Frye Chiropractic, Inc Clinic/Center 42283 10th St W, Suite 107, Lancaster, CA 93534-7073 2006-07-11

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Competitor

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City LANCASTER
Zip Code 17601

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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